Journal of the National Cancer Institute Advance Access originally published online on September 25, 2007
JNCI Journal of the National Cancer Institute 2007 99(19):1484-1489; doi:10.1093/jnci/djm153
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© The Author 2007. Published by Oxford University Press.
ARTICLES |
Needle Biopsies on Autopsy Prostates: Sensitivity of Cancer Detection Based on True Prevalence
Affiliations of authors: Departments of Urology (GPH, NBD, RFJ) and Pathology (VC, MJ, GT, GdlR), State University of New York Upstate Medical University, Syracuse, NY; Departments of Epidemiology and Biostatistics (AMS, AJV) and Urology (RK, HL), Memorial Sloan-Kettering Cancer Center, New York, NY; Onondaga County Medical Examiner, Syracuse, NY (MJ)
Correspondence to: Gabriel P. Haas, MD, Department of Urology, State University of New York Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210 (e-mail: haasg{at}upstate.edu).
Background: It is difficult to estimate the diagnostic accuracy of biopsy for prostate cancer because men with negative biopsy do not undergo radical prostatectomy and thus have no confirmation of biopsy findings.
Methods: We performed 18-core needle biopsies on autopsy prostates from 164 men who had no history of prostate cancer. Six-core biopsies were taken from each of the mid peripheral zone (MPZ), the lateral peripheral zone (LPZ), and the central zone (CZ). We tested associations between age and tumor characteristics and analyzed the sensitivity of biopsies at each site. All statistical tests were two-sided.
Results: Prostate cancer was present in 47 (29%) prostates. Of the 47 cancers detected, 20 were clinically significant according to histologic criteria. Tumor volume was associated with tumor grade (P = .012) and with age (P<.001). The biopsies from the CZ did not detect any cancer that was not present in biopsies of either the MPZ or LPZ. The sensitivity of the biopsies taken from the MPZ and LPZ together (53%, 95% confidence interval [CI] = 38% to 68%) was therefore the same as that of 18-core biopsies and was superior to that of biopsies of the MPZ alone (30%, 95% CI = 17% to 45%) (P = .003). The sensitivities of biopsies from the MPZ for clinically significant and insignificant cancer were 55% (95% CI = 32% to 77%) and 11% (95% CI = 2% to 29%), respectively, compared with 80% (95% CI = 56% to 94%) and 33% (95% CI = 17% to 54%) for those from the MPZ and LPZ combined.
Conclusions: The ability to detect prostate cancer was more related to the biopsy site than to the number of biopsy cores taken. The 12-core biopsies, six cores each from the MPZ and LPZ, were most likely to detect the majority of clinically significant cancers but also detected many insignificant cancers. When the six-core biopsies from the CZ were added, no increase in sensitivity was observed.
| CONTEXT AND CAVEATS Prior knowledge The accuracy of detecting prostate cancer in prostate biopsies is difficult to determine because most men whose biopsies do not show cancer do not undergo radical prostatectomy to confirm the results. Study design Eighteen-core needle biopsies were performed on autopsy prostates of men who had not been diagnosed with prostate cancer, six cores each from the mid peripheral zone (MPZ), the lateral peripheral zone (LPZ), and the central zone. The sensitivity and specificity of detecting prostate cancer from the biopsies were analyzed, as were associations between age and tumor characteristics. Contributions Of the 164 prostates biopsied, prostate cancer was detected in 47, of which, according to histologic criteria, 20 were felt to be clinically significant. Tumor volume was associated with age and tumor grade. The sensitivity of the 12-core biopsies taken from the MPZ and LPZ was similar to that of all 18-core biopsies and was higher than that of the six-core biopsies from the MPZ. Implications The anatomic location of the biopsy was more important than the total number taken. Limitations The study sample size was relatively small. None of the men had a previous history of prostate cancer, and all died of causes unrelated to prostate cancer, so all of the prostate cancers detected in this study would have been considered clinically insignificant.
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Manuscript received April 10, 2007; revised July 24, 2007; accepted August 13, 2007.
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J Natl Cancer Inst 2007 99: 1421.
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